What is Apo’?

Apomorphine (Apo’) is a prescription-only drug with a chequered history. Discovered in the 1800s, it was originally used as an emetic (it can empty a stomach in seconds) and became a mainstay in veterinary practice. It was also associated with punishment and bizarre “cures” for homosexuality typified by this quote from “Philomena” (2013) by Martin Sixsmith:

“David pulled himself together. He told him about the aversion therapy: how they had tried to cure his sinful desires by strapping electrodes to his genitals, by giving him apomorphine to make him vomit at the sight of pictures of naked men; how he was locked in a windowless room in a psychiatric ward; how it went on and on and on.”

Much of this was mythical but in the precise world of scientific reality Apo’ is now used in effective and safe regulation of the on-off periods experienced by sufferers of Parkinson’s disease, it has also been used for erectile dysfunction and is regarded as a useful investigative tool within the pharmaceutical industry. In the middle of the 1900s it was also found to be effective in the treatment of anxiety and drug dependency and in particular amongst doctors and their patients who favoured abstinence over any form of drug maintenance or replacement therapy. It is to this last area that this website is primarily devoted.

As a tool against addiction Apo’ is therefore ill served by the suffix “morphine”. Whilst it is true that Apomorphine is derived from a chemical ratio of both morphine and hydrochloric acid boiled at 140 degrees centigrade, it actually shares none of the properties of morphine. To be clear:

Morphine is an opiate that delivers a euphoric effect; Apo’ does not.

Morphine is highly addictive; Apo’ is not. There is no black market for Apo’.

Morphine is an analgesic (pain killer); Apo’ is not.

So, what is Apo’ and what does it do?

Apo’ is an inert colourless liquid that, if spilled, stains green.

Apo’ has a short half-life which means its (pharmacokinetic) effect within the body wears off quickly.

Apo’ is a ‘generic’ drug; one that cannot be patented to make fortunes for any particular drug company unless allied to a novel way of administration; pump, inhalant, transdermal patch, etc. or, unless its chemical structure is ‘tweaked’ to combine with other compounds.

Above all else Apo’ is best known as one of a group of drugs called ‘dopamine agonists’ which have some affinity with the naturally-occurring chemical and neurotransmitter dopamine. However, Apo’ is a unique drug amongst this group because it alone has an almost exact synthetic match for dopamine with some affinity for all its receptor sites; D1 through to D5. This is of particular interest in respect of addiction because dopamine reinforces motivational behaviour central to our wellbeing, comfort and survival. Consequently when we take a drug for the first time our brains are briefly hijacked to think that this salient experience is critical to survival. In that way dopamine stimulates us to remember and learn the strategies that led to that “high” so we can repeat them in the future.

This mechanism is termed the “reward system”, or pathway, and it is partly to this reinforcing impulse that addiction is attributed. It is also understood that those who suffer from addiction often have flawed dopamine function. Somewhere in their brains the wires are crossed, either due to a heritable trait or as a consequence of addiction itself. It is therefore hypothesised that the dopamine agonist Apo’ repairs some of this lost function and the addict, with improved cognition and reduced cravings, can benefit from subsequent adjunct therapies enabling him to break the old, destructive habits, replacing them with positive life affirming strategies.

In this way it was claimed that treatment with Apo’ had a neurobiological stimulus that facilitated adaptive behaviour for the recovering addict but very few people were convinced. Apo’ as a detox tool was ignored or discredited; it was assumed its only therapeutic dimension was attributable to a contra-conditioning stimulus known as “aversion” (similar to the Philomena quote above). This fallacy endures to this day. Apo’ was also discredited as being “dangerous”, “addictive” and reliant on the doctor’s “charisma” for success.

Subsequently, however, none of this was corroborated by a number of independent and unrelated practitioners who also used Apo’ against addiction. They too found that it was therapeutic, that it was not “aversion” and not even addictive or dangerous. The question is why such a discrepancy between these opposing interpretations and what is the truth?

It is extremely unlikely that Apo’ as a successful treatment for addiction will ever be sought or offered. It belongs to a different era when doctors knew their patients and could lead them step by step through the pain of withdrawal towards recovery. This was a neuropharmacological treatment based on an individual pathology and psychology, and identified by compassionate specialists who, armed with decades of experience and hundreds of successful treatments, knew how to avoid the pitfalls and relapse.
However, and this point cannot be overemphasised, as a historical barometer of our drugs laws and the dogma that has helped define them the “apomorphine story” is of great, if neglected, significance. The fact that nobody chose to examine the true “efficacy” of Apo’ reveals much about this confused and compromised area of medicine that, by the 1950s, had become increasingly tangled in the insidious web of geo-politics, the lead up to the unwinnable”war on drugs” and the medicalization of misery compounded by a sudden increase of spurious conditions potentially treated by prescription dependency.

Tellingly, by the middle of the Twentieth century, the emerging orthodoxy was that addiction could be relieved by talk therapy, maintained or replaced by a bewildering range of psychotropic drugs, with or without a psychological interpretation of its underlying cause and physiological effects. This was at the point when psychiatry evolved under a new flag of convenience, exchanging the introspective fad of Freud for the insidiousness of Big Pharma as its principle raison d’etre.

Apo’ on the other hand sprang from an entirely different premise; that sufferers of addiction would be best served by a non-addictive and short neuropharmacological intervention that repaired the damaged bio-chemical structure of the brain to relieve anxiety, withdrawal and the compulsion to seek and use. In today’s context of drugs like Acamprosate and Naltrexone for drinking and remedies like Champix for smoking Apo’ can therefore be seen as similar in concept if not in terms of the detail of its neural mechanism.

Furthermore, Apo’ was demonstrably successful as an adjunct to support and follow-up psychotherapy by doctors close to the patient’s own community and in a variety of clinical settings and countries. This is particularly ironic in light of the National Institute for Clinical Excellence’s (NICE) recent impotent and facile policy termed the “brief intervention”, a short consultation whereby doctors might get to the point with their patient where a few home truths about their drinking might reduce the burden of a problem which currently costs society more than £12 billion a year. Superficially the “brief intervention” might appear to be a good idea but practically isn’t it a bit rich to expect the modern patient with his realistic expectation from a bewildering array of drugs to suddenly accept a prescription of little more than common sense?

DEPTFORD HIGH STREET – April 2014. “Poundshop, Pawnbroker, Bookmaker”

Additionally, how on earth can it be practical in this “pill a day” culture against a background of depersonalised high streets, pharmacies, betting shops and fast food outlets to ask the modern G.P. to resurrect what politicians and bureaucrats, aided and abetted by the pharmaceutical industry, happily dismantled all those years ago: the deeply respected patrician physician? Back in the day that was the norm and curiously one of that breed also used Apo’ for addiction.

This is his story.

(What follows is a greatly abbreviated biography which refers to events that had a bearing on one man’s pioneering and profoundly ethical efforts to understand and treat addiction and how this evolved into a successful and systematic treatment using Apo’ that did not preclude other approaches.)

He did. A much abbreviated account of his meeting with Dent and subsequent treatment can be found here; Chapter Five: https://apomorphineversusaddiction.com/chapter-five-want-friend-washington-get-dog/
The important distinction is the unhelpful use by Burroughs (and others) of the word “cure”. Dent did not think that a cure from addiction was strictly possible. He preferred to use the word treatment.
“Cure” he felt was a matter between the patient and himself.

Cheers Calequandi. It’s a racket for sure and made worse by the lazy/trusting culture of deference shown to the supremely white coated with their “evidence based medicine” mantra. Until research is truly independent of all pecuniary interest we’ll never know. Those within the scientific community who, for instance, talk fallaciously about APO without even the first idea of how it was used. Extraordinary. They’re about as scientific as Hecate.

You raise some interesting points about the cross cultural possibilities allied to the hidden “wisdom” of plants. Indeed this is probably my next area of interest.

How absolutely REFRESHING to read such a brilliantly written, succinct appraisal of the paradigm in which we [addicts] are mired…I am absolutely full-throttle impressed by the author’s scope of understanding ~ this syndrome and the related peripherals that accompany it are a fascinating and lethal entity, an amorphous ever shifting CREATURE which if one can suspend ‘normal’ approaches to perspective, they may at once apprehend the true nature of this Monster….I swear it is ALIVE…I just can’t say enough about how truly moved I am by this article it resonates deeply with me: I have, since around 2005ish been intimately involved with cutting edge, experimental and rather radical treatment approaches with regard to heavy hardcore chemical dependency…The approach and wonderfully ETHICAL attitude targeting the Beast with what basically amounts to ‘new’ ‘weaponry’ because you bet your life this is WAR.. I have over twenty sessions under my belt using a controversial method and Medicine called Ibogaine – a naturally occurring compound derived from the root-bark of the Tabernanthe iboga perennial shrub which grows only in 3 countries in equatorial Africa: Congo, Cameroon and Gabon. The indigenous use the raw root bark in massive doses for initiation ritual and shamanic healing ceremony. They have used this holy medicine for centuries, it is ABSOLUTELY worthy of any and all praise and crazy internet hype you may come across…this is the ONE the only singular material that I have ever come across in my hugely intense search for such a panacea, hundreds of risky ‘trips’ and strange encounters endeavoring ever to discover that ‘thing’ -the elusive element that HAS to be ‘out there’ somewhere….something the Creator put here for just such a purpose. I firmly believe there isn’t a single disease, syndrome,pathogen, infection or otherwise unwanted disturbance to human beings for which there isn’t ALREADY an effective and specifically ‘targeted’ remedy for growing under our very noses. Something not mentioned in this spectacular article is the interesting origins of Apo – though to be sure I am only a heavily experienced layman, I can 100% back up any and all the information I disseminate in places like this – not just some rouge psychonaut looking for a place to troll: that said, apomorphine is one of many naturally occurring dopamine agonists found in a wide variety of plants – notably Nymphaea caerulea (blue lotus) and has untold amounts of anecdotal and indigenous lore going back many centuries – both Mayan and Egyptian societies are thought to have imbibed these plants for many of the same reasons they are being explored and prescribed today, they also [rightly] revered and held in great esteem the virtues that these gifts expressed, all of this to my mind and in my own experience and observation, these are all ‘signs’ taken collectively they SHOUT ‘hey! over here!’ to our blind and narcissistic post-modern conceits. We don’t know SHIT if we insist on endless tail chasing ensconced in a fluorescent, sterile laboratory – we’ll reap experiments which barely graze the whole potential of these Medicines. These are meant to be used in conjunction with each other, there is a definite synergy and the INTENTION of these creatures becomes crystal clear if one has the temerity to lay down their social programming and SEE with the sight given us, that Creation intended a SYMBIOSIS – a living relationship which [this sounds strange to contemporary ears] involves COMMUNICATION with the living things which we seek to help us heal…this statement alone in its very core and by default impels the Mob to flagrant divisiveness, easily branded ‘New Age’ or weird fluffy pseudo-science, a term gaining popularity among ‘real’ ehem….’scientists. Disgustingly, and this is just s vulgar display of avarice: the single element in the struggle to get people’s perspective to change, is the bludgeoning battery of diabolical BIG PHARMA who HATES phyto-therapies of ALL kinds because you cannot patent a plant. I work also with Kambo, a secretion derived from the endocrine systems of Giant Monkey tree frogs in Amazonian rain forests – these chemicals are used in much the same fashion and for many of the same reasons/indications of Apo – there are peptides, one of which [Dermorphin] is a partial opiate agonist but has zero abuse potential – this Medicine is hardcore and likely a half percent of everyone who ever reads this article would endeavor to explore its potential….I realize this has become a bit of a rant, but the article is so damned well done, so sweetly heavy-duty in its confident momentum to reveal basic, intrinsic, TRUTH and REALITY to minds wholly conditioned to immediately marginalize such research and the number one weapon is ridicule…you don’t even have to engage the real point of any essays like this, because those who are employed to ‘keep the streets clean’ of any/all discussions regarding natural or ‘alternative’ remedies. Fear dominates such behavior, and in itself is telling all about its terror of the simple subtle impenetrable inviolate and IMMANENT truth, they shall in the end, fall. In so doing may they look up from their fallen places and behold the mercy which ever existed just outside their very windows….the holy salvation and mysterious wonder bequeathed us by the Creator of All…can people not SEE the Mercy? It intends us to COOPERATE and assist one another to employ the virtues of these magnificent living things which everyday we glance over never once giving serious thought to expressions of these creatures. They are not ‘animal’ yet they are for certain not ‘inanimate’ – there are studies abound, peer-reviewed empirical stuffy academic data showing proof absolute that plants respond to certain specific stimuli in ways unlooked for, unaccounted for UNLESS – one thinks OUTSIDE their boxes – their industrial consumer shell, and OPENS their mind to allow themselves the CAPACITY to absorb unorthodox possibilities and perhaps explore a fascinating new realm…well – ‘new’ to us -we who at best and on rare occasion, stop to smell a rose – or gaze admiringly on the delicate blooms of chrysanthemum – here is a good look at something wonderfully intriguing – a gentle introduction in learning to understand how HUGE the potential is for us to share communication with the Plant Kingdom. One Love.

The current use of apomorphine to treat erectile dysfunction suggests a useful and informative study. Namely, among patients who were or are being so treated for erectile dysfunction, did any of those who also presented with an addiction or addictive tendency find that their addiction was alleviated as a fortuitous associated outcome?

Of course, one possibility that would need to be controlled for, is whether the addictive tendency was itself a coping mechanism that the patient used to soothe the distress caused by their erectile dysfunction – lowered self-esteem, fear of relationship breakdown,and so on. In other words, did their addiction resolve because the cause of their unhappiness – erectile dysfunction – was alleviated?

Naturally, the study samples used in attempting to answer these two questions would comprise only males.

Difficulties in sourcing and gaining access to this data might be complicated by current data protection and privacy policies. However, I would imagine that the data could be provided in such a way as to neither reveal the identity of the patients concerned or enable this to be ascertained.

The other factor would be funding of the study. I would guess that a charitable body such as the Leverhulme Trust, who may be more oriented towards the humanities and social sciences, might be freer than some of the mainstream research councils to support a well formulated study of this kind.

You have made some interesting points. Your first was posed in respect of dependency amongst Parkinson sufferers but the onset of PD usually results in a cessation of other activities that exacerbate the symptoms of dyskinesea; i.e. drinking.
In 2003 a Scottish study suggested that Apomorphine was effective in treating “sexual dysfunction” amongst women. (Ian Russell, specialist in urology, Dumfries Royal) Presumably, libido, between the genders, is dependent on different mechanisms. For men it is a “plumbing issue” but for women desire is linked more to “mood and being relaxed”. Failure of performance amongst the intoxicated is widely understood, and could indeed be a cause of anxiety. AS the Bard said; “….it provokes the desire, but takes away the performance.” (Macbeth, Act 2 Scene, 3) Certainly, therefore, any inability to perform may result in anxiety that then leads to self medicating with booze or other drug and inevitably, a further decline in performance.
There is precious little point in funding any research into alcohol treatment all the while support for the “drinking industry” remains so entrenched. There has been a five fold increase in liver disease attributable to alcohol since 1970. Our legislators, currently, do not want to address this problem and yet they mouth platitudes about the disease burden, cost to society, etc.
Apo’ represented a preventative culture which society has long lost sight of, moreover, within the industry of “addiction therapies” few believe that Apo’ is anything other than “aversion”.